The american journal of psychiatry

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THE

AMERICAN

JOURNAL

OF PSYCHIATRY

Editorial

Grief:

A

Normal

odd looking
his early

woman
Her

attempt

43-year-old,

life,

who

found

“made

death

led

him

(uncommon

establish

a relationship

live without

adaptability,

in his

was

mind.

with

What

should

issue

of the Journal

have

pose

that

suchtaken

complicated

In his

a step

toward

sive

response

object
mental
logical

by the

His

aspect

in

inseparable.

a serious

perhaps

and

of extreme

devastation

suicide

correct,

His discovery
at the

that

ability

good

as he searched

of human

and

Grief

and

Empirical

her

to

fortune

sudden

loss

for thiswoman

existence,

colleagues

attachment

in this

Depression

in Elderly

in differentiating

and

in an article

Bereavement-Related

Validation

understanding,

grief, with persistent
1917
paper,
“Mourning

for the twentieth
century
cal responses
to the loss

niche.

and

and

a circumstance

Prigerson

Preliminary

tender

his belief,damaged

to a 57-year-old

is normality?

(“Complicated

Disorders:

been

her.”

to be unrelenting

this central

problems.

extremely

marriage

had

reflected

was

What

man,

a depression)

to “join

to a narrow

is pathology?

loss,

that

woman

but promised

surprising

They
(not

his wish

Variants

18-year-long

reaction

grief)this

admittedly

It is hardly

Distinct

grief

her and

inevitable

impaired

in an

feel ten feet tall.”

in “normal”

not

not only

intellectually

redemption

to an intense

he could
and

and Pathological

Bereaved
syndromes

two

as

Spouses”)
of loss:

yearning
for the lost person,
and depression.
and Melancholia,”
Freud (1) providedthe setting

dialogue
about the range of normal
grief and the pathologiof a person.
He differentiated
normal
grief from the depres-

presence

of shame

and

guilt

in the

latter.

Yearning

for the

lost

was part of the normal
response
to loss and was gradually
overcome
as the
representation
was “decathected.”
The mechanisms
underlying
the pathoresponse
wereattributed
to the nature
of the antecedent
relationship
between

the survivor
and
object
relationship.

the

sequelae

of loss

uniquely

criterion

of a pathological

We no longer
responses.

The

lost person,
More
recent

think

from

and

accompany

severe

grief

responses,

(3-5).

years

ago,

Lindemann

Fifty

the presence
of anambivalent,
such as Clayton
(2) have

the perspective

response

in simple

vegetative

namely,
observers

of depression,

narcissistic
examined
the

as if it were

the

sole

to loss.

dichotomous
psychomotor

and grief
published

terms

about

symptoms

normal
of

and

depressive

pathological
disorder

may

may persist
for extended
periods
oftime
in this journal
(6) a seminal
article
in

which
he described
a variety
of”morbid
g&f reactions,”
among
them various
manifestations
of hostility,
hyperactive
behavior,
acquisition
of symptoms
of the deceased,
“psychosomatic
illnesses”
such as ulcerative
colitis,
rheumatoid
arthritis,
various
disturbances
of social
interaction,
intense
yearning
as a separatePrigerson
and her colleagues
cated
loss.

Am

J

Psychiatry

and frank depression.
He did not isolate
syndrome.
have set the stage for the differentiation
for the lost
longitudinal

grief
Their

152:1,

(persistent
carefully

January

1995

yearning
designed

person)
study

from
clearly

the depressive
differentiates

persistent,
of compliresponses
between...
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